Saturday, December 19, 2015


      All of us know about the self destruction of the cassette in the episodes of Mission Impossible. In medicine we know there are many example of cell destruction . The red cells will die in 120 days from the time they are released in the circulation . The platelets , which are important  for the clotting have life of 7 days . Same thing happens with many tissues and many times There was a time when an experiment was done to see as to how long cells can continue to multiply if they are provided adequate nutritional support and environment in the Lab.In the beginning it was felt that the cells has unlimited ability to multiply. But then it was realised that when new chicken broth was added as nutritional support , thew were adding New Cells . Subsequent work showed that each cell has Fixed Limit. This is called Hafflick factor. When the skin of old mice was transplanted in younger mice the the cells lasted longer . However the limit was there.So this about the medicine , but the Self destruction that I am talking today is about behavioral destruction. I have seen this in my medical like. But this one of the story.
     I saw this 40 years old female in my office for chronic cough. She also had some shortness of the breath . She was in ER few times . This had started few months ago and she had seen a lung specialist I saw the old -2 months old Ct scan . It showed that she had Interstitial lung disease . I saw the old record . She had some lymph node enlargement and the lung specialist had done biopsy of the nodes and told her that 'everything was OK' .I decided to do new CT scan and the pulmonary function tests. The Ct scan did show that she was worsening in the inflammation in the lungs and breathing test did show that scars had affected the test. The process of transferring the oxygen is called diffusion and that is impaired when there are scars .This is called Diffusion capacity . I did do another broncoscopy and biopsy , but no definite diagnosis was established So I asked a chest surgeon to do the open biopsy . It showed specific reason for the inflammation and the scars . I had done all the tests to rule out that etiology called connective tissue disorder (Lupus or Rheumatoid arthritis etc )I started her on steroids and tried to send to Mayo clinic or other centers , but had problem with her insurance . She continued ti get worse. So I sent her for transplant evaluation . She was felt to be a good candidate, and they decided to start the work up , so that she can be put on Active list . The it happened . She was admitted for shortness of breath . Someone did a Drug test on the urine and it showed positive for cocaine .She got worse and needed 50 L oxygen .But she was not accepted for the transplant as she had used cocaine . They would not accept her till she is 6 months drug free .
                      THIS IS WHAT I CALL SELF DESTRUCTION ! 

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